Diagnosis & Treatment

Symptoms of Latex Allergy Reactions

Contact Dermatitis

Type IV Hypersensitivity

Type I Hypersensitivity

  • Itching
  • Redness
  • Hives
  • Runny nose
  • Anaphylaxis
  • Difficulty breathing

Diagnosing Latex Allergy

History and physical are crucial to diagnosis. A blood test (RAST test) may be done to detect antibodies but it is often unreliable since a person with a positive history may have a negative RAST test. Often, a scratch test is done. The skin on the forearm is pricked and a solution containing latex is dropped on the area. If the area becomes red, swollen, and itchy within 15 minutes, the test is positive. However, there is no commercially available testing solution. This leads to variance in the amount of latex in the solution used by different physicians, since they make their own. A patch test is similar in that a piece of latex glove is applied to the arm for up to 15 minutes. Hives with itching or redness indicates a positive response. The physician may not even do the scratch or patch tests on a person with a strong history, as the tests themselves have caused some people to experience anaphylaxis.

Treatment

Patients with a confirmed latex allergy should wear a medic alert bracelet at all times. Currently, there is no cure for latex allergy; prevention and avoidance are the best treatment options. Allergy shots (desensitization or immunotherapy) are not approved for use in the United States because they have caused Type I reactions. The other bad news is that this is a progressive allergy; each exposure increases sensitization and the chance of an anaphylactic reaction.

Researchers in Europe have conducted clinical trials on immunotherapy for latex allergy. In one study, administering oral and subcutaneous natural rubber latex allergens significantly lowered the incidence of rhinitis, conjunctivitis, and skin reactions; however, it did not significantly affect asthma associated with latex allergy. In another study, there were a large number of systemic reactions to the latex injection during both the initial therapy and the monthly maintenance injections (Rolland & O'Hehir, 2008). Since people may react to different combinations of the latex proteins, it will be difficult to find a common treatment for all latex allergy sufferers. Therefore, immunotherapy is considered an experimental treatment, and avoidance of exposure is the primary treatment and means of prevention.

There have been many advances in latex allergy research. For example, the specific proteins that are the major allergens for people with spina bifida have been isolated, and it's been discovered that they are not the same proteins that are the primary allergens in healthcare workers (Peixinho, Tavares-Ratado, Tomás, Taborda-Barata, & Tomaz, 2008). This may be explained by a difference in the routes of exposure between the two groups, and different means of subsequent sensitization. The allergens that affect children with congenital malformations (such as spina bifida) are particle-bound proteins that are less soluble than other latex proteins. Sensitization to these proteins may be caused by repeated mucosal contact. Healthcare workers tend to be exposed primarily through topical and respiratory contact since they wear latex gloves for long periods of time, and constantly inhale the powder that is all around them. It's been theorized that neonates who develop latex allergy are sensitized by inhaling the powder from latex gloves worn in the delivery room. Studies done with mice show that the mice develop IgE antibodies to specific combinations of latex proteins based on the type of exposure they've had (injected vs. topical vs. inhaled). There's still a lot of research to be done, but isolating the specific allergens to each population and method of exposure gives hope that there may effective treatments developed in the future.

Prevention

First, notice if you have any of the above symptoms. Healthcare workers are so good at taking care of others that we tend to overlook ourselves. If you do have symptoms, (especially at work but not at home), keep a journal to find a pattern. Ask your doctor or allergist to be tested for latex allergy and remind them that you are at high risk because of your occupation, and even more so if you have other allergies. There is also a hereditary component to latex allergy, so find out if anyone in your family has symptoms. Finally, avoid latex gloves as much as possible.



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